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This state of the Academy address was presented at the opening ceremonies of the fourth annual scientific meeting of the American Academy of Health Behavior by the outgoing president of the Academy, February 29, 2004.
Mentally retarded males with a fragile site on the X chromosome (Xq27) were observed to exhibit a highly idiosyncratic but well-coordinated, stereotypic form of gaze avoidance during greeting ceremonies that involved the whole upper body. A comparison group of persons with other etiologically defined syndromes of mental retardation did not. Results suggest that the aberrant greeting behavior may be uniquely associated with one syndrome of mental retardation with a defined genetic etiology. The behavior pattern does not appear until middle childhood, however, and its developmental induction remains to be explained.
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The Philadelphia College of Osteopathic Medicine has developed an exercise to introduce professional ethics and behavior at the earliest stages of medical education. During orientation, each incoming class creates a class vision statement. After small group discussions on professional ethics, honesty, and responsibilities, representatives from each group collated student input and constructed a class vision statement reflective of student consensus on these issues. Each vision statement was recited as an oath during the white coat ceremony at the conclusion of the orientation program. Despite the fact that previous vision statements were unavailable to each incoming class, there were many commonalities among the statements created. Central elements of all vision statements include commitment to altruism, compassionate treatment of patients, and honesty and integrity in all professional interactions. Humility, the capacity to recognize and accept one's limitations in knowledge and skills, was also a key element in each statement. Three of four statements specifically recognized the teamwork and mutual respect that should be engendered among all members of the health care team. Each vision statement had prominent statements regarding the learning process during osteopathic medical school and acknowledged the importance of active and lifelong learning in the students' career paths. Student evaluation of this exercise has been positive, especially the recitation of the statement during the white coat ceremony. Results suggest that the development of a class vision statement represents a powerful mechanism for addressing the importance of professional attitudes, behaviors, and ethics at the earliest stages of medical education.
Free rotational aerophones such as the bullroarer, which consists of a wooden slat whirled around on the end of a string, and which emits a loud pulsating roar, have been used in many ancient and traditional societies for ceremonial purposes. This article presents an experimental and theoretical investigation of this instrument. The aerodynamics of rotational behavior is elucidated, and relates slat rotation frequency to slat width and velocity through the air. Analysis shows that sound production is due to generation of an oscillating-rotating dipole across the slat, the role of the vortices shed by the slat being relatively minor. Apparent discrepancies between the behavior of a bullroarer slat and a slat mounted on an axle in a wind tunnel are shown to be due to viscous friction in the bearings of the wind-tunnel experiment.
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The fundamental aim of this study was to identify factors crucial for the development of effective cancer prevention programs for American Indian (AI) populations. Toward that end, we developed an instrument to assess the influence of traditionalism on health risks such as smoking, consumption, and obesity. A population-based survey was conducted among 559 randomly selected women living on the Hopi reservation aged 18 years and older, from July through December 1993. To construct a traditionalism score, we conducted focus groups in the community. A multidimensional approach was adopted by assessing three dimensions of native culture: language usage; cultural participation, or participation in such activities as Hopi ceremonies; and percentage of life spent off-reservation. A mean score of the three dimensions was computed for each respondent. High levels of traditionalism were significantly associated with disease protective behaviors, such as practicing traditional Hopi activities to keep healthy (OR = 3.07), and significantly inversely associated with disease risk factors such as smoking (OR = 0.26) and obesity (OR = 0.60) independent of age, marital status, and education. As these data provide a strong rationale for the promotion of traditions in public health programs aimed at decreasing rates of chronic disease among AI women, we conclude this paper with a discussion of the importance of traditionalism and how it might be accurately assessed.
PURPOSE/OBJECTIVES: To describe the grieving behaviors and selected death beliefs and rituals for two Latino groups: island Puerto Ricans and Mexican immigrants. DATA SOURCES: Published articles, book chapters, books, government documents, and clinical experience. DATA SYNTHESIS: Limited scientific research exists on the grieving process and beliefs about death of Latinos. Death is seen as an extension of life in some Latino cultures, a belief that seems to assist positively in the grieving process. Rituals and ceremonies to honor the dead still are practiced in many Latino cultures and are rooted partly in their cultural heritage. CONCLUSIONS: Nurses caring for Latinos with cancer can provide better care with an understanding of grieving behaviors observed early in the disease process and at the time of imminent death. IMPLICATIONS FOR NURSING PRACTICE: Culturally competent care can be given when beliefs and values about death are understood. Allowing Latino clients to grieve and honor the dead in a culturally appropriate way will enhance the nurse/client/family relationship.
The unique urogenital anatomy and histology of female spotted hyenas (Crocuta crocuta Erxleben) was reexamined to identify adaptations of "structure" that enable/facilitate urination, mating, and parturition through the clitoris. Unusual features of penile anatomy required for meeting ceremonies and successful mating through a clitoral point of insertion were also examined. As reported previously, the upper urogenital tract of the female spotted hyena is typical of other carnivores and consists of the oviducts, uterine horns, uterine body, and vagina. An anatomically defined cervix is absent, even though a histologically defined transition zone between the uterine body and vagina was demonstrated. Adaptive features of the upper genital tract were a helical-shaped uterine cavity, extensive smooth muscle in the uterus and vagina, and a newly discovered submucosal mucous urogenital gland (SMUG) located immediately caudal to the vagina. The extensive smooth muscle facilitates the expulsion of the large pups at parturition through the recurved birth canal. Secretions of the SMUG provide lubrication and protection for the urogenital mucosa during mating and parturition. Two types of "erections" are suggested by behavioral observations: the common hemodynamic erection required for insertion and thrusting by the male, and phallic "flipping" that commonly occurs earlier in the mating sequence and is sometimes seen during meeting ceremonies. Phallic "flipping" appears to be accomplished by the coordinated contractions of the large ischiocavernosus and retractor muscles acting on the semirigid organ. The extremely thick tunica albuginea and interstitial collagen of the common corporal body of the penis and clitoris gives the flaccid phallus some degree of rigidity even in the resting state in males and nulliparous females. Phallic "flipping" implies a hinge region in which flexibility is the key feature. Such a proximal hinge region of the male and female phallus was defined and was notable for its diminished collagen content. The urogenital sinus traversing the clitoris was specialized for distensibility, thus facilitating receipt of the penis during mating and for passage of the infant to the tip of the glans clitoris, where it emerges at parturition. The morphology of the glans penis is notable for the tapered common corporal body that extends to the distal tip of the glans. This adaptation is suggested to be required for a clitoral (as opposed to a vaginal) point of insertion during mating. Finally, additional segments of erectile tissue devoid of a thick collagenous capsule were demonstrated in the glans penis and glans clitoris, which appear to account for the "partially-locking" of the male into the female during the late stages of a mating sequence. Taken together, it is evident that the unusual sexual behaviors of the male and female spotted hyenas are facilitated by unique structural modifications of the relevant organs.
There is no one formula for culcure change. A joint steering committee of staff members can develop plans that will build trust, address each other as equals, and drive out fear as they move the process of change. Training and sharing information help staff recognize this is a process, not an event. New well-screened team members need training to integrate them into the culture. It is important to identify the knowledge and expertise of team members to maximize their energies and talents. Recruitment and retention of those who share the values of this culture are of paramount importance. It is worth the time and effort to secure commitment to these values. One example of this effort is a facility in Pennsylvania that, at its worst, had two thirds of its staff turnover in a year. The national average was 82% in 1995, an increase from 71.5% the year before. They were able to reduce their turnover rate to 27% by examining the hiring records and finding that workers with certain personality traits and attitudes were less likely to leave. They looked for compassion and communication skills, perceptions of older adults, ability to cope with death and dying, and ability to handle the unpleasant tasks of residene hygiene and bathroom visits. Current staff members determined and voted on best fit of candidates (Montague, 1997). Although training and evaluation are an important component of retention and commitment to values in any organization, training and evaluation of nursing home employees may be quite different from other employment. A nurse in a nursing home needs to be evaluated not only on clinical skills, but on communication skills, attitude, and leadership (Meyer, 1995). Then training and employee development programs can be targeted to specific areas for corrective action. What is taught in training and what occurs on the job should correspond, or role conflict occurs increasing the likelihood of turnover (Steffen, Nystrom, O'Connor, 1996). Although occasional exit of poor performers and fresh ideas of new recruits can be beneficial, inability to retain experienced personnel can result in replacement costs as high as $7,000 per employee (Proenca & Shewchuk, 1997). Furthermore, fostering employee commitment also has a mediating effect on family members' satisfaction with service quality (Steffen, Nystrom, & O'Connor, 1996). Each organization must be sensitized to its own problems. Attitudes cannot be changed by rules. Staff members need to be involved with listing all the strengths and weaknesses and how to change the negatives to positives in their own facilities. This requires a continuous learning process. The learning organization usually needs to restructure to improve its operation to reduce the hierarchy. If all employees understand the reasons for change and have participated in the change process, they are more likely to have learned organizational values such as trust, commitment, honesty, and integrity by inculcating these values and teaching them to others. Every employee is a partner in building a good reputation for the organization. One person can make a difference in creating, protecting, and building an organization's good name (Young, 1996). Staff members need to have a collaborative relationship with those who survey them, those who use their services, and those who compete with them. That does not mean "cronyism" (a dishonest, close relationship), but an honest, sharing relationship that fosters problem-solving and sharing of best practices. Leaders of the future must be more flexible with a broader variety of experiences. Their ceremonial responsibilities as the head of the organization become a critical and necessary function (Steere, 1996). Ceremonies, rites, and rituals bind the members to the organization. The values and culture work well because leaders exhibit these values in their interactive communication behaviors. The trend toward increasingly empowered organizations addresses the need to move decision-making to lower levels, leaving the leadership role to one of clearly articulating and demonstrating a sense of purpose and direction dedicated to excellence and quality.
The use of the resin of Virola elongata as an arrow poison was investigated. Aqueous and methanolic extracts of the dried bark were not observed to have toxic effects when administered intraperitoneally to mice. In an attempt to determine if the hallucinogenic indole alkaloid constituents of the bark, which form the basis for the alternate use of this material as a ceremonial snuff, could also be responsible for its use as an arrow poison, alkaloidal and non-alkaloidal extracts were compared with respect to their behavioral effects on mice. The non-alkaloidal extract was more effective in producing an observable alteration in behavior. This consisted of a marked reduction in spontaneous locomotor activity. The extract was fractionated and 13 of the major constituents assayed for their ability to reduce spontaneous locomotor activity. Most of this biological activity of the extract was attributable to the presence of the bis-tetrahydrofuran lignans, epi-sesartemin, sesartemin, epi-yangambin and yangambin. Each of these compounds was also observed to reduce isolation induced aggression when administered to mice.
Ethnicity can be a confusing concept. In part, it includes inherited characteristics such as race. Certain other aspects are learned, such as religion, language, attitudes, values, or customs. National origin of oneself or one's kin can be a component of ethnicity. Group affiliation and participation in certain ritual and ceremony are also involved in ethnicity. Substance abuse and dependence may undermine certain aspects of ethnicity and ethnic affiliations, by interfering with traditional values, attitudes, preferred behaviors, and interpersonal relationships. Substance abuse leads to the evolution of new values, attitudes and behaviors. These are remarkably similar (though not identical) from one chemically dependent person to another. In some cases the chemically dependent person remains a social isolate, while in other cases the individual joins with others to create a subculture in which the drug or alcohol centered values, attitudes and behaviors are shared. Treatment for alcoholism or drug abuse--is successful--produces crisis in ethnic identity for many people. Drug centered values and behaviors are directly confronted in the treatment process, and affiliation with alcohol or drug subcultures is specifically undermined. This may create a state of anomie--with its attendant confusion, anxiety, and loss. Out of this turmoil some individuals resume their original, childhood ethnic identities and affiliations (though often more accentuated than before). Others assume new ethnic identities or affiliations.
Marriage is universal, and pair bonding is found in other species too with highly dependent young. So marriage functions as a reproductive social arrangement that traditionally involved the extended family. The sexes are not identical in their biological contributions to children's survival, so they seek somewhat different attributes in a mate. Men seek a young, attractive, sexually faithful bride. Women seek a man who is older, taller, and (as in many other species) socially dominant. Both sexes prefer a kind, healthy, attractive, similar mate who is emotionally attached to them. A spouse who fails to maintain sufficiently high mate value is vulnerable to divorce. Infertility and sexual dissatisfaction predict divorce, as does death of a child, but the more children, the stabler the marriage. Cross-cultural data suggest that cruel or subdominant men (e.g., poor providers) and unfaithful women are prone to divorce. Marriages in which the wife dominates the husband in economic contributions, nonverbal behavior, and decision making tend to be less satisfying. In societies in which wives are economically independent of husbands, divorce rates are high. As women's economic power has risen with industrialization, divorce rates have climbed. Economic and fitness considerations also help explain cultural differences in polygyny, age at marriage, arranged marriage, concern with the bride's sexual chastity, and marriage ceremonies. Other factors also affect marital dynamics, such as state subsidies to families, the sex ratio, and influence of the couple's parents.
CONTEXT: There is a growing consensus among medical educators that to promote the professional development of medical students, schools of medicine should provide explicit learning experiences in professionalism. OBJECTIVE: To determine whether and how schools of medicine were teaching professionalism in the 1998-1999 academic year. DESIGN, SETTING, AND PARTICIPANTS: A 2-stage survey was sent to 125 US medical schools in the fall of 1998. A total of 116 (92.3%) responded to the first stage of the survey. The second survey led to a qualitative analysis of curriculum materials submitted by 41 schools. MAIN OUTCOME MEASURES: Presence or absence of learning experiences (didactic or experiential) in undergraduate medical curriculum explicitly intended to promote professionalism in medical students, with curriculum evaluation based on 4 attributes commonly recognized as essential to professionalism: subordination of one's self-interests, adherence to high ethical and moral standards, response to societal needs, and demonstration of evincible core humanistic values. RESULTS: Of the 116 responding medical schools, 104 (89.7%) reported that they offer some formal instruction related to professionalism. Fewer schools have explicit methods for assessing professional behaviors (n = 64 [55.2%]) or conduct targeted faculty development programs (n = 39 [33.6%]). Schools use diverse strategies to promote professionalism, ranging from an isolated white-coat ceremony or other orientation experience (n = 71 [78.9%]) to an integrated sequence of courses over multiple years of the curriculum (n = 25 [27.8%]). Of the 41 schools that provided curriculum materials, 27 (65.9%) addressed subordinating self-interests; 31 (75.6%), adhering to high ethical and moral standards; 17 (41.5%), responding to societal needs; and 22 (53.7%), evincing core humanistic values. CONCLUSIONS: Our results suggest that the teaching of professionalism in undergraduate medical education varies widely. Although most medical schools in the United States now address this important topic in some manner, the strategies used to teach professionalism may not always be adequate.
This article traces various historical and geographical aspects of multicultural toothpick use, dating back from prehistoric times to the present. This behavior appears to be one of the oldest and best documented of all human habits. Toothpicks (composed of bone, ivory, metal, plastic, quills, wood or other substances) have been used for ceremonial, oral hygiene and religious purposes. Throughout the ages, the act of toothpicking has been both encouraged and discouraged. In the 19-20th centuries, it was generally viewed as a disgusting breach of social etiquette and a significant threat to oral and general health. Authors of numerous dental articles have cautioned that indiscriminate toothpick use can lead to halitosis, dental caries, injury to the interdental papilla, mouth ulcers, allergic reactions, embedment of the device in the back of the mouth or throat, gingival abscesses, sensitive teeth, or abraded enamel, dentin or cementum of both permanent and primary dentitions. Additionally, both the dental and medical literature report anecdotal cases of life-threatening injuries and death caused by toothpick ingestion.
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The present study surveyed male gay couples to determine how their relationships began and were maintained, the types of conflict they experienced, and how the issues of monogamy, sexual behavior and AIDS affected the relationships. Ninety-two couples responded to the survey. The gay bar was the most common initial meeting place and relationships had lasted from less than one to 35 years. Few had had a commitment ceremony, although many reported wanting one if it were available. Most of the close friends of respondents were also gay couples and about two-thirds of family members were supportive of the relationship. The most persistent conflicts centered around finances and relations with family members. Virtually all respondents described their relationships as monogamous, but only about half practiced safe-sex. More attention needs to be given to understanding male couples and to targeting AIDS-prevention messages to them.
The sportscasters' metaphor, "on and off the playing field," is used to describe the altruistic demeanor of good ethical and moral behavior and empathy toward patients that is required of medical students and physicians. It has been noted that these altruistic qualities often compete unsuccessfully with scientific skills and scholarly pursuits. Many schools hold the "White Coat Ceremony" annually and host a chapter of the Honor Medical Society to instill these traits in students. Teaching of altruistic demeanor is most successful using a combination of techniques, which include philosophy, virtue theory, small-group discussions using case vignettes, and the structured objective clinical examination with "standardized patients." On the playing field, current major issues are intellectual honesty, mandatory testing/treatment for HIV/AIDS, abortion, end-of-life issues, and gene therapy. Off the playing field, family, religion, community service, and leadership will immortalize medical students in the mythical Health Care Hall of Fame.